The director of adult and pediatric kidney transplantation at IU Health has performed more than 2000 kidney transplants in Indiana and won't slow down any time soon.
IndyStar

Buy Photo

Dr. William Goggins (right) talks with Julie Brophy at IU Health University Hospital on April 12, 2018. Goggins has performed 2,000 kidney transplants in his 20-year career. In February, Brophy was his 2,000th transplant patient.(Photo: Jenna Watson/IndyStar)Buy Photo

The closer Dr. William Goggins drew to performing his 2,000th kidney transplant, the more aware he became of that milestone. He knew his colleagues would be watching and he didn’t want anything to go wrong.

“You’re like, 'Oh wow, I wonder who it’s going to be?' ” said Goggins, director of adult and pediatrics kidney transplantation at IU Health. “And, of course, I decided to pick a really immunologically complicated lady with a complex kidney. … That turned out to be my 2,000th. Oh my God, I should have picked a straightforward, easy living donor, brothers, no issues.”

Then Goggins, 52, guffawed, a loud hearty laugh that often punctuated his ruminations on his career of nearly 20 years.

Surgeons aren't sports stars. While the United Network for Organ Sharing compiles program-level data, no one keeps statistics on individual surgeons. So it's impossible to know how rare it is for a surgeon to perform this many procedures over his or her career, much less partway through it.

And, added Emond, Goggins may have several years of operating ahead of him.

To Goggins, there's nothing more interesting than kidney transplants. And the more complicated the surgery, the better.

“Everybody thinks, how can you just do kidney transplants? It’s the same surgery over and over. And, well, obviously you don’t know anything about kidney transplants,” he said. “The concepts are the same, but everybody is different.”

A typical kidney transplant will take Goggins from two to three hours, although more complicated procedures may go longer. It's demanding, physical work that requires bending over, delving deep into a patient's abdominal cavity, and doing the painstaking job of sewing the donor kidney into the recipient.

Initially, Goggins said, he planned to retire in his 70s. When he reached his mid-40s and his back started to bother him, he thought, maybe 65. Now that he’s in his 50s, he wonders whether he can keep up a breakneck pace of 150 transplants a year.

Patient 2,000

Patient No. 2,000 is more than a number to Goggins. She’s Julie Brophy, a Carmel woman who needed her second kidney transplant after her husband had given her one of his in 2001. Five years later, his kidney failed, and Brophy, 45, went on the transplant waiting list for another one.

Finding a good match was difficult because of her previous transplant. And the average wait for a kidney is three to five years, according to the National Kidney Foundation. People with complicated immune systems, like Brophy, can expect to wait much longer.

Buy Photo

Dr. William Goggins stands for a picture with Julie Brophy at IU Health University Hospital on April 12, 2018. Brophy received her kidney as part of a paired kidney exchange.(Photo: Jenna Watson/IndyStar)

Kidney transplants are by far the most common of organ transplants. More than 1,110 people in Indiana are waiting for a kidney. Many of those rely on regular dialysis to stay alive, a grueling regimen that takes hours a week.

Brophy's kidney came earlier this year, as part of what's known as a paired kidney exchange. How that worked: A friend of hers donated a kidney on her behalf; the organ went to another donor who was a match. Then, Brophy was matched with a kidney from a different donor.

On Feb. 27, Goggins attached a new kidney to Brophy’s abdomen.

At first, the kidney wasn't warmly welcomed by its new owner. Brophy developed antibodies against the new organ, but Goggins patiently tweaked her anti-rejection medications. Within a few weeks, Brophy, who has a 7-year-old son, was back home.

“My new kidney was struggling, and he’s been able to turn everything around. He’s just a remarkable life saver,” Brophy said. “Dr. Goggins is one of the few people in the country who was able to help me.”

Before he arrived in Indianapolis, Goggins had performed about 150 kidney transplants. He had some experience with other transplants but had already developed an affinity for kidney surgeries.Unlike liver-transplant patients who can take months to recover, kidney-transplant patients can recover rapidly.

“You put in a good kidney, you do a nice operation, and they get healthy very quickly and they’re like a new person within 24, 48 hours and it’s just, an awesome experience,” Goggins said.

When he came to Indianapolis in 2003, Goggins set a personal goal of doing about 100 kidney transplants a year. His first three years here, he did about 85 transplants a year, working alongside two colleagues. Then one left and the other retired about 10 years ago. Goggins found himself performing from 160 to 180 kidney transplants a year.

By May of 2012, Goggins hit 1,000 kidney transplants.

At one point, he recalled, he performed 365 transplants over two years, each one taking two to three hours. That adds up to every other day for two years straight.

Buy Photo

Dr. William Goggins is a surgeon specializing in kidney transplants. “There would be some times when I would do 12 kidneys in four days, five days. It’s like feast or famine,” he said.(Photo: Jenna Watson/IndyStar)

Goggins still remembers the first kidney transplant he did, in July 2000, after he finished his training at Massachusetts General Hospital. The kidney came from a living donor.

"I didn’t sleep well the night before, because I kept going over the steps of the operation in my head. I was terrified that I might forget something," he said. "The transplant went very smoothly, no issues at all."

These days, there is no typical week for Goggins. Some weeks, he doesn’t do any transplants. Other weeks, he’ll do 10.

“There would be some times when I would do 12 kidneys in four days, five days. It’s like feast or famine,” he said. “If you’re doing two a day, you sort of get into a routine.”

Three procedures a day, however, can tax even Goggins. When his schedule fills up, his elliptical and kettle ball workouts tend to go by the wayside. Goggins jokes that you can look at his waistline to determine how busy he’s been.

'One of my biggest character flaws...'

Over the years, Goggins has seen many changes in transplant surgeries. He’s made a career out of doing increasingly complicated transplants, where recipients often have developed antibodies that work to attack the transplanted organs. People typically develop these antibodies for one of three reasons — they have had a blood transfusion, a prior transplant or are women who have been pregnant.

“What happens is you sort of get immunized against the general population, so it’s like a flu shot for the general population,” he said.

When Goggins entered the field, kidney transplant patients could only receive an organ from donors who had a compatible blood type. Now, the recipient’s blood can be filtered to remove the potentially deal-breaking antibodies. The dialysis-like process, known as plasmapheresis, is typically done before the transplant. This disarms the body’s immune response and after transplant, the recipient will go on the normal regimen of medications to prevent rejection.

Johns Hopkins University surgeons led the field in this practice in the early years of this century. In Boston at the time, Goggins followed their path, doing two of these cases.

Time proved that this process could work, opening the door for many more patients to undergo kidney transplants. Over the years, science has also found ways to assess the antibodies present in the donor, determine which ones could cause problems for the recipient, and focus on those.

Not every program offers this level of sophistication. That means Goggins and his colleagues often accept patients that others turn down. About one-third of the transplants he does now fall in this category. Some programs refuse to transplant even perfectly matched kidneys if some level of antibody has the smallest chance of negatively impacting the success of the operation.

“Most transplant centers if they have a positive crossmatch, say no, but I look at it as more why not, why can’t we?” he said. “One of my big character flaws is I can’t say no to people, so I’m always trying to figure out a way to get people transplanted. … We end up saying yes to a lot of people that many people say no to.”

Kidney transplants: When are you too old?

Often patients find their way to IU’s program after waiting for years at other programs, where their doctors are looking for that perfect organ. Goggins hopes to be able to offer them an organ within a few weeks or months after they sign up through the IU list. Sometimes patients come to him after hearing that dialysis is their only hope for survival. Recently he did a kidney transplant for a woman who had been on dialysis since 2006.

Nor does Goggins let a patient’s age dissuade him from performing a transplant. In his early years in Indianapolis, a 65-year-old woman came to him because she needed a procedure to allow her to continue on dialysis. He asked whether she had looked into having a transplant and she said, "I came here seven years ago and they told me I was too old then." She had a transplant.

In fact, patients over 60 are the fastest-growing group of kidney transplant patients, Goggins says. Studies have shown that people in this age range with a life expectancy of five to 10 years will do better with a kidney transplant than they would staying on dialysis.

Goggins now wants to conduct a study in which he performs kidney transplants on people over the age of 65, using organs from people infected with the virus hepatitis C. At the time of transplant, these recipients, who might not otherwise receive a new kidney in their lifetime, would be given a drug to treat the virus in the hope of preventing transmission.

Goggins’ willingness to push the envelope does not have a negative impact on statistics. The program’s overall one-year survival rate is 95.5 percent, compared with a national rate of 95.2 percent. Three years out, the program shines, with a three-year overall survival rate of 92 percent and a living donor survival rate of 96 percent, compared with expected rates of 88 and under 94 percent, respectively. Goggins attributes this success to his staff, which is meticulous about doing follow-up on transplant patients.

To this date, Goggins has not met any other transplant surgeon who comes close to his record of kidney transplants.

So, then, if he had to turn to a kidney surgeon, perhaps to donate a kidney to a family member in need, how would he choose his own surgeon?

“I would either try to figure out how to do it with mirrors — no, I’m kidding. … I’m trying to figure out how I could do both at the same time, because I would want the best to put my kidney in,” he said, laughing again loudly and then saying he would trust one of his partners to do the job.

For now, Goggins plans to become more involved working with the vexing problem of how to tame antibodies that could pose obstacles to a transplant. But he still sees a role for himself in the operating room. After all, he says, a less-experienced surgeon would not necessarily be able to do the difficult cases that he can handle.

Before he retires, Goggins said, he’d like to hit the 3,000 or even 3,500 transplant mark.

When he reached 2,000 he said, he felt relieved that the benchmark was behind him.

“Now I could just focus on transplanting people,” he said. “Everybody gets gifts and talents, mine just happens to be putting kidneys in people.”

Call IndyStar reporter Shari Rudavsky at (317) 444-6354. Follow her on Facebook and on Twitter.

IndyStar’s “Gifted: How Organ Donation in Indiana Saves Lives” series is made possible through the support of the Indiana Donor Network, a nonprofit organization committed to saving and enhancing the quality of life through organ, tissue and eye donation and transplantation.